Causes, Symptoms, Recovery, and Survival

Untreated appendicitis may cause your appendix to rupture (burst), resulting in an infection. Symptoms associated with a ruptured appendix include severe abdominal pain, fever, chills, and weakness.

Appendicitis is inflammation of the appendix. This small, thin, finger-shaped sac is located on the lower right side of your abdomen, where your small and large intestines connect. Most doctors think the appendix doesn’t have an important function and can be removed without causing harmful effects.

If your appendicitis is left untreated, your appendix can rupture (burst). When this happens, bacteria get released into your abdomen and can cause a serious infection.

A ruptured appendix, also known as a perforated appendix, can make you very sick and is sometimes hard to treat.

The risk of rupture increases the longer that appendicitis treatment is delayed. The risk is about 2% 36 hours after symptoms start. After that, the risk increases by about 5% every 12 hours.

The biggest risk factor for a ruptured appendix is delaying treatment for appendicitis. The longer you wait to address your symptoms, the higher your risk.

According to a 2018 literature review, younger children are more likely to have a ruptured appendix than older children. This is because they have more trouble explaining their appendicitis symptoms to others.

The exact cause of appendicitis is unknown, but experts think an infection triggers inflammation inside the appendix.

For instance, If something blocks the opening of the appendix, an infection can follow. Bacteria can get trapped inside the appendix and multiply quickly, causing appendicitis. Viruses, parasites, and stool buildup may cause the blockages and infections that result in appendicitis. Inflammatory bowel disease (IBD) is another possible cause of appendicitis.

When appendicitis isn’t treated promptly and correctly, bacteria or pus build up. As this happens, pressure increases and the appendix swells. Eventually, it swells so much that the blood supply to part of the appendix gets cut off. That part of the appendix wall dies, and a hole or tear develops in the dead wall. The high pressure pushes the bacteria and pus into the abdominal cavity.

A ruptured appendix usually oozes or leaks into the abdomen instead of bursting like a balloon.

Risk factors for appendicitis

Appendicitis can happen at any age, but it often affects children and teens between the ages of 10 and 20 years. It’s more common in people who were assigned male at birth.

Having other family members with appendicitis can increase your risk too. Children with cystic fibrosis are also more likely to have appendicitis.

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Appendicitis symptoms can be similar to those of other conditions that affect the abdomen, such as a stomach virus or an ovarian cyst. For this reason, it can be hard to tell if you have appendicitis.

The classic symptoms of appendicitis are pain starting around the belly button and then vomiting. Several hours later, the pain moves to the lower right abdomen.

If you have these symptoms and think it might be appendicitis, seek medical attention as soon as possible. Quick treatment is essential to avoid a rupture.

Other symptoms of appendicitis include:

• abdominal pain that may start in the upper or middle abdomen but usually settles in the lower right abdomen
• abdominal pain that increases when you walk, stand, jump, cough, or sneeze
• a bloated or swollen abdomen
• tenderness when you push on your abdomen, which may get worse when you quickly stop pressing on it
• an inability to pass gas
• fever
• nausea along with vomiting
• decreased appetite
• constipation or diarrhea

Keep in mind that not everyone who gets appendicitis has these classic symptoms. It’s common for kids and older adults to have more unusual symptoms.

In babies and children, the pain is often spread out all over the abdomen. Caregivers should look for pain that starts around the child’s belly button and moves to the right side, along with appetite loss and fever.

In older people, the abdomen may be less tender, and pain may be less severe.

Appendicitis inflames the appendix and causes it to swell. Without treatment, the pressure eventually reaches the point where the appendix bursts. This can happen as quickly as 48 to 72 hours after your symptoms start.

Once your appendix ruptures, you may have a variety of symptoms. At first, you may feel better for a few hours because the high pressure in your appendix is gone, along with your original symptoms.

Peritonitis

When bacteria leave the intestine and enter the abdominal cavity, the lining of your abdominal cavity becomes inflamed. This condition is called peritonitis.

Peritonitis can be very serious and very painful. It requires immediate treatment.

The symptoms of peritonitis are similar to those of appendicitis, except:

• the pain is in your whole abdomen
• the pain is constant and more severe
• your fever is often higher
• your breathing and heart rate may be fast because of fever, infection, or severe pain
• you may have other symptoms, including chills, weakness, and confusion

Abscess

When you have an infection in your abdomen, the surrounding tissues sometimes try to wall off the infection from the rest of your abdomen. The wall forms an abscess, a closed-off collection of bacteria and pus.

Symptoms of an abscess are also similar to those of appendicitis, except:

• the pain may be in one area (but not always the lower right abdomen), or it may be in your entire abdomen
• the pain can be either a dull ache or sharp and stabbing
• the fever doesn’t go away, even when you take antibiotics
• you may have other symptoms, such as chills and weakness

Sepsis

When left untreated, the bacteria from a ruptured appendix can enter your bloodstream, causing a serious condition called sepsis. Sepsis is inflammation throughout your entire body.

Symptoms of sepsis include:

• fever or a low temperature
• fast heartbeat and breathing
• chills
• weakness
• confusion
• low blood pressure

The treatment for a ruptured appendix is to remove your appendix with surgery.

Doctors sometimes wait to perform surgery on a child who isn’t in any immediate danger. The surgeon will drain infected fluid from the abdomen, have the child take antibiotics, and remove the appendix later. The name for delayed surgery is interval appendectomy.

Peritonitis

The treatment for peritonitis is to clean bacteria out of the abdomen during surgery.

You’ll usually get antibiotics through a vein, at least for the first few days. You may need to receive hospital treatment for 10 to 14 days to ensure the infection is gone.

Abscess

Often, your appendix will be removed right away. If there’s a large abscess, your doctor might want to drain it before surgery. A tube inserted into the abscess lets the bacteria- and pus-filled fluid drain out.

This process can take several weeks. You might go home with the drain in place, and you’ll need to take antibiotics while the drain stays in place.

Once the abscess is drained and the infection and inflammation are controlled, your doctor will perform your surgery.

Sepsis

Antibiotics are the main treatment for sepsis. It’s important to start taking these medications as soon as possible, because the infection is life threatening if left untreated.

Duration of treatment may vary, but shorter treatment courses are generally preferred, according to a 2020 study.

You’ll need to take antibiotics once your ruptured appendix is removed or a drain is put into an abscess. You’ll typically take antibiotics before, during, and after surgery.

The length of antibiotic treatment will vary. Your surgeon will analyze your case to determine the best plan for you.

One 2021 study recommended that postsurgical antibiotic treatment be limited to 3 to 6 days.

Open surgery (instead of minimally invasive laparoscopic surgery) is typically used for a ruptured appendix. It helps your doctor ensure all of the infection is cleaned out.

After surgery, you’ll need to keep the incision clean and dry. Avoid taking a bath or shower until your doctor says it’s fine to do so.

It can take up to 6 weeks to fully recover from open surgery. Try not to lift anything heavy or participate in sports or other strenuous activities during this time. Your recovery will take longer if you have a drain inserted and shorter if you have a laparoscopic procedure.

You may take strong prescription pain medication for a few days after surgery or after a drain is placed. After that, you can usually manage the pain with over-the-counter (OTC) medications such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol).

Your doctor may encourage you to get up and walk as soon as possible after surgery. You may have to adjust your diet and eat smaller meals while you heal.

You should be able to return to work or school around 1 week after surgery, depending on how you feel.

Considerations for children

A child whose appendix has ruptured may need to stay in the hospital for 1 week or so.

A 2022 study recommended that children who’d undergone laparoscopic surgery and had a normal white blood cell count discontinue antibiotics at the time of their hospital discharge.

Others may come home with a special tube called a peripherally inserted central catheter (PICC line) so they can get antibiotics through a vein at home.

Kids should stay on a liquid diet for a couple of days after surgery. They should wait until they have their follow-up visit with the surgeon, and get the surgeon’s approval, before going back to their regular activities. This could take up to 3 weeks.

Without quick treatment, a ruptured appendix is a life threatening condition.

When the appendix hasn’t perforated, the risk of death is under 1% according to a 2020 literature review. The risk can be as high as 5% if the appendix has perforated.

Treating a ruptured appendix increases the odds of survival.

If you get medical attention right away for appendicitis, you have a better chance of fully recovering if your appendix ruptures. That’s why it’s important to see a doctor if you have any symptoms of appendicitis.

There’s no way of knowing when or if appendicitis will happen, so you can’t prevent it. However, you can avoid a rupture if you get immediate treatment.

The key is to know the symptoms of appendicitis. If you have any abdominal pain combined with nausea or other symptoms, get medical help immediately.

See a healthcare professional even if you’re unsure if your symptoms are appendicitis. It’s better to find out that you don’t have appendicitis than to wait and have your appendix rupture.

Appendicitis | Johns Hopkins Medicine

What is appendicitis?

The appendix is a thin tube that is joined to the large intestine. It sits in the lower right part of your belly (abdomen). When you are a young child, your appendix is a working part of your immune system, which helps your body to fight disease. When you are older, your appendix stops doing this and other parts of your body keep helping to fight infection.

The appendix can get infected. If not treated it can burst (rupture). This can happen as soon as 48 to 72 hours after you have symptoms. Because of this, appendicitis is a medical emergency. If you have symptoms, see a doctor right away to avoid more infection, which can be life-threatening.

What causes appendicitis?

Appendicitis happens when the inside of your appendix is blocked. Appendicitis may be caused by various infections such as virus, bacteria, or parasites, in your digestive tract. Or it may happen when the tube that joins your large intestine and appendix is blocked or trapped by stool. Sometimes tumors can cause appendicitis.

The appendix then becomes sore and swollen. The blood supply to the appendix stops as the swelling and soreness get worse. Without enough blood flow, the appendix starts to die. The appendix can burst or develop holes or tears in its walls, which allow stool, mucus, and infection to leak through and get inside the belly. The result can be peritonitis, a serious infection.

Who is at risk for appendicitis?

Appendicitis affects 1 in 1,000 people living in the U. S. Most cases of appendicitis happen to people between the ages of 10 and 30 years. Having a family history of appendicitis may raise your risk, especially if you are a man. For a child, having cystic fibrosis also seems to raise the risk of getting appendicitis.

What are the symptoms of appendicitis?

The following are common symptoms of appendicitis. Your own symptoms may vary.

Pain in the abdomen is the most common symptom. This pain:

• May start in the area around your belly button and move to the lower right-hand side of your belly. It may also start in the lower right-hand side of your belly.
• Often gets worse as time goes on.
• May feel worse when you are moving, taking deep breaths, being touched, and coughing or sneezing.
• May be felt all over your belly if your appendix bursts.

Other common symptoms include:

• Upset stomach and vomiting
• Loss of appetite
• Fever and chills
• Trouble having a bowel movement (constipation)
• Loose stool (diarrhea)
• Trouble passing gas
• Swollen belly

Do not take pain medicines. They may hide other symptoms your healthcare provider needs to know about.

Appendicitis symptoms may look like other health problems. Always see your healthcare provider to be sure.

How is appendicitis diagnosed?

Your healthcare provider will ask about your past health and do a physical exam. He or she may also have you take the following tests:

• Blood tests: To check for signs of infection, such as having a high white blood cell count.
• Urine tests: To see if you have a urinary tract infection.

You may also have some imaging tests, including:

• Abdominal ultrasound: Lets the doctor see internal organs as they work and checks how blood is flowing through different blood vessels.
• CT scan: Shows detailed images of any part of the body, such as the bones, muscles, fat, and organs.
• MRI: Sometimes used to diagnose appendicitis, especially in a pregnant woman, instead of CT scan.

How is appendicitis treated?

Appendicitis is a medical emergency. It is likely the appendix will burst and cause a serious, deadly infection. For this reason, in almost all situations, your healthcare provider will advise that you have surgery to remove your appendix.

The appendix may be removed in an open procedure or using laparoscopy:

• Open (traditional) surgery method. You are given anesthesia. A cut (incision) is made in the lower right-hand side of your belly. The surgeon finds the appendix and takes it out. If the appendix has burst, a small tube (shunt) may be placed to drain out pus and other fluids in the belly. The shunt will be taken out in a few days, when your surgeon feels the infection has gone away.
• Laparoscopic method. You are given anesthesia. This surgery uses several small cuts (incisions) and a camera (laparoscope) to look inside your belly. The surgical tools are placed through a few small incisions. The laparoscope is placed through another incision. A laparoscopy can often be done even if the appendix has burst.

If your appendix has not burst then your recovery from an appendectomy will only take a few days. If your appendix has burst, your recovery time will be longer and you will  need antibiotic medicine.

You can live a normal life without your appendix. Changes in diet or exercise are usually not needed.

Complications of Appendicitis

The main problem with appendicitis is the risk of a burst appendix. This may happen if the appendix is not removed quickly. A burst appendix can lead to infection in the belly, called peritonitis. Peritonitis can be very serious and even cause death if not treated right away.

Can appendicitis be prevented?

At this time, there is no known way to stop appendicitis from happening.

When should I call my healthcare provider?

If you have any of the symptoms of appendicitis listed above, call your healthcare provider right away. Or go to an emergency department. Appendicitis is a serious medical emergency. It should be treated as quickly as possible.

Key Points About Appendicitis

Appendicitis is when your appendix becomes sore, swollen, and diseased.

• It is a medical emergency. You must seek care right away.
• It happens when the inside of your appendix gets filled with something that causes it to swell, such as mucus, stool, or parasites.
• Most cases of appendicitis happen between the ages of 10 and 30 years.
• It causes pain in the belly, but each person may have different symptoms.
• Your health care provider will advise that you have surgery to remove your appendix.
• You can live a normal life without your appendix.

Next Steps

Tips to help you get the most from a visit to your healthcare provider:

• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

Acute appendicitis

Acute appendicitis is an acute inflammation of the appendix (vermiform appendix of the caecum), requiring urgent surgical treatment, one of the most common inflammatory diseases of the abdominal organs.

What is the “appendix” and why does it become inflamed?

The appendix arises from the lower end of the caecum (the beginning of the large intestine). It is believed that the appendix is ​​one of the links of the immune system, since the mucous membrane of the appendix is ​​rich in lymphoid tissue. It is generally accepted that inflammation of the appendix may occur due to blockage of the appendix lumen by enlarged lymphoid tissue, fecal stones (hard stools resulting from chronic constipation), a foreign body, and sometimes helminths. Blockage leads to expansion of the appendix cavity, the rapid development of infection and inflammation. However, the exact cause of this common disease is not clear.

Symptoms of acute appendicitis

Manifestations of acute appendicitis depend on the location of the appendix, the time elapsed from the onset of the disease, the severity of the inflammatory process in the appendix and the involvement of nearby organs and peritoneum, as well as the age of the patient and the presence of concomitant diseases.

Since the appendix is ​​a mobile organ, its inflammation can mimic almost any disease. In some cases, doctors have difficulty in making a diagnosis, since the main symptom of appendicitis – pain – can occur not only in the right lower abdomen, where it should be located according to the anatomy of the caecum, but also in the navel, in the groin, above the pubis , in the lower back, in the right hypochondrium and disguised as diseases of the liver, kidneys, female genital organs.

As a rule, the disease begins with the appearance of pain in the upper abdomen, which gradually increases, moves to the right iliac region (right lower quadrant of the abdomen). The pain is aggravated by coughing and movement. Usually there is a subfebrile body temperature of 37.2-37.5 ° C. Examination of the abdomen reveals involuntary tension of the muscles of the anterior abdominal wall and pain in the right iliac region. The pain is constant and may be accompanied by nausea and sometimes vomiting. There is often loss of appetite and refusal to eat, as well as stool retention caused by restriction of intestinal motility due to inflammation spreading through the peritoneum.

Unfortunately, these classic signs of appendicitis are observed in just over half of patients with acute appendicitis. The pain may not have a clear localization, especially in children under 3 years of age. In elderly and senile patients, reduced reactivity of the body, connective tissue replacement of all layers of the appendix wall and its blood vessels contribute to poor symptoms of acute appendicitis and a large number of complicated forms. In pregnant women in the second and third trimesters, a uterine appendix may cause an atypical clinical picture. Therefore, so often patients with acute appendicitis come to the emergency surgery department already with complications (perforation of the appendix, peritonitis).

What is “phlegmonous” and “gangrenous” appendicitis?

If the patient’s symptoms of appendicitis are mild, but, nevertheless, the inflammatory process develops (the pain is not very strong, there is no nausea and vomiting), he is in no hurry to seek medical help, and then catarrhal appendicitis turns into a phlegmonous form. The appendix fills with pus and ulcerates. Inflammation begins to spread to the surrounding tissues: the walls of the intestine, the peritoneum. The pain becomes more pronounced, aggravated by the tension of the abdominal muscles; in thin people, the inflamed process can be felt as a dense roller.

Phlegmonous appendicitis can turn into a gangrenous form, when the inflammatory process develops already in the abdominal cavity. With gangrenous appendicitis, there is a decrease or complete absence of pain associated with the death of the nerve endings of the appendix, but signs of general intoxication, deterioration of the general condition: weakness , pallor, bloating. If at this stage the patient is not helped, the patient’s life is at risk due to the development of peritonitis.

How is appendicitis diagnosed?

If acute appendicitis is suspected, the patient must be urgently admitted to a surgical hospital. In the EMC Surgical Clinic, emergency operations are performed around the clock for acute appendicitis and its complications.

At the stage before hospitalization, even in the presence of a pronounced pain syndrome, one should not take painkillers, as this may complicate the diagnosis of the disease. You should also not use antibiotics, as this can blur the picture with the further development of complications (perforation of the process, diffuse peritonitis).

Diagnosis begins with a thorough questioning and examination, as well as taking a blood test (a complete blood count usually reflects inflammation – an increase in the number of leukocytes, leukocytosis occurs). In the classic course of acute appendicitis (high temperature and pain in the right iliac region from tolerable to very strong), the diagnosis is not difficult. For patients with questionable or unclear symptoms, doctors may order an abdominal and pelvic ultrasound and/or computed tomography when admitted to the hospital.

In some cases, a diagnostic Laparoscopy can be performed, a diagnostic procedure in which a thin fiber optic tube with a camera is inserted into the abdominal cavity through a small opening in the abdominal wall. Laparoscopy allows you to see the appendix and other organs of the abdominal cavity and pelvis and assess their condition.

Acute Appendicitis Emergency

Surgery to remove an appendix (inflamed appendix) is called an “appendectomy” in which the inflamed appendix is ​​removed.

In the presence of perforation (rupture) of the appendix, the surgical intervention becomes technically more difficult to perform. There is a need for a thorough “washing” of the abdominal cavity from pus. Consequently, both the operation itself and recovery can be delayed.

Removal of the appendix is ​​preceded by intravenous antibiotics to prevent complications. If there is a perforation of the appendix, antibiotic treatment continues until the blood tests normalize (approximately 5-7 days). The question of the abolition of antibiotics is decided by the attending physician.

Laparoscopic Appendectomy

As a general rule, in EMC, most of the surgical interventions for acute appendicitis, even in the case of severe forms of the disease, are performed laparoscopically, which guarantees a minimum of pain and a shorter recovery period. In uncomplicated appendicitis, if the appendix has not been perforated, the patient is usually discharged the next day. Patients with a perforated appendix may stay in the clinic longer (up to 7 days), especially if peritonitis has developed.

However, there are some cases where traditional open surgery (open appendectomy) is preferred.

With timely surgical intervention, recovery occurs quickly.

Gangrenous appendicitis – medical center “YOUR DOCTOR” Shakhty

Surgery

Diagnosis of abdominal pain is always difficult due to the difficulty of access to the problem area. Gangrenous appendicitis also belongs to diseases that are difficult to detect. It is characterized by rapid suppuration and death of the tissue of the appendix, leading to a rupture of its wall – perforation.

Symptoms

Inflammation develops rapidly. The pain is less pronounced than with ordinary appendicitis, which is explained by cell death. However, general intoxication causes severe manifestations:

• Pain from umbilicus to lower right side;

• Repeated vomiting;

• Tongue dry, covered with a layer of brown coating;

• Chill, cold perspiration;

• No temperature rise;

• Rapid pulse;

• Sharp pain from light contact with the abdomen.

These symptoms require immediate medical attention. Before the arrival of the medical team, you should not use medicines.

Causes

Appendicitis is the most common reason for surgery. Numerous studies have not made it possible to explain the mechanism of development of this disease, but it is not difficult to identify the reasons for the formation of gangrenous degeneration. In any part of the body, cell death develops in a similar pattern. Lead to gangrenous complication:

• Late diagnosis;

• Old age;

• Violation of blood circulation in the peritoneum;

• Thrombosis of the vessels of the appendix;

• Atherosclerosis;

• Subsequent infection;

• Autoimmune reactivity.

Gangrenous appendicitis often accompanies other diseases that are not always associated with the abdomen. These include:

• Influenza, SARS;

• Tuberculosis;

• Gastric ulcer;

• Colitis;

• Oncology;

• AIDS

Gangrenous appendicitis may occur with weak peristalsis. The slow progress of the intestinal masses contributes to stagnation in the process, which can provoke decay and intoxication.

Medical assistance

A patient with appendicitis is urgently hospitalized. Gangrenous appendicitis is a serious disease that requires urgent treatment by a surgeon. To exclude erroneous diagnoses, the patient will be asked the following questions:

• How the disease manifests itself;

• When the symptoms appeared;

• What pathologies have you had recently.

Next will be an examination of the abdomen, CT scan or X-ray, analysis of tests.

Removal of the process is carried out in several ways:

• Abdominal surgery. A festering appendix is ​​removed through an incision in the peritoneum and a suture is applied;

• Laparoscopy. Through small punctures, an optical device and manipulators are introduced into the cavity, which make it possible to detect and cut off the process.

A timely operation will allow the patient not to feel serious complications and quickly restore his ability to work.